Objective: We aimed to assess the short- and long-term outcomes of bilateral subthalamic (STN) deep brain stimulation (DBS) including the motor performance and quality of life (QoL) in Parkinson’s disease (PD) patients with and without REM sleep behavior disorder (RBD).

Background: Bilateral STN DBS improves non-motor symptoms as well as motor symptoms of PD, and long-term follow-up studies have tried to prove these outcomes. PD patients with RBD might have some specific clinical features more commonly than those without RBD. However, few studies examined the outcomes of STN-DBS according to the presence of RBD.

Method: We retrospectively reviewed patients who underwent DBS for PD from September 2011 to November 2018 in Seoul National University Hospital. 102 PD patients (55 with RBD, 48 without RBD) were evaluated 1-year after STN DBS and 33 of them were also examined 5-year after STN DBS. Patients were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) I, II, III,, Hoehn & Yahr (H&Y) scale, Short Form-36 Health Survey (SF-36) for health-related QoL (HRQoL), Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Parkinson’s Disease Sleep Scale (PDSS) and Minnesota Impulse Disorders Interview (MIDI). Changes from baseline for the measured variables were analysed by independent sample t-test between two groups and paired t-test within the group.

Results: Our results showed that the long-term poor outcome was sustained for 5-year after STN-DBS in PD patients with RBD. There were significant differences in the changes between with or without RBD in axial subscore of UPDRS part III (p=0.026) and physical-component summary (PCS) of SF-36 (p=0.036). Especially, the two variables related to SF-36 are significantly worse than the baseline (p=0.011). Similarly to 5-year follow up, axial subscore was significant differences between both groups (p=0.021) and there was a trend toward greater difference in the PCS of SF-36 for 1-year follow up. None of the changes in non-motor symptoms including cognitive dysfunction, depression, sleep problem and impulsive-compulsive disorder.

Conclusion: Our study confirmed that RBD appeared to affect the short- and long-term poor outcomes on motor performances, especially axial symptom and HRQoL of life in PD patients after STN DBS.

References: 1. Ronald B. Postuma, Jean-Francois Gagnon, Melanie Vendette, Katia Charland, Jacques Montplaisir. Manifestations of Parkinson Disease Differ in Association with REM Sleep Behavior Disorder. Mov Dis 2008;23(12)1665-1672. 10. R B Postuma, J F Gagnon, M Vendette, K Charland, J Montplaisir. REM sleep behaviour disorder in Parkinson’s disease is associated with specific motor features. J Neurol Neurosurg Psychiatry 2008;79:1117–1121. 2. R B Postuma, J F Gagnon, M Vendette, K Charland, J Montplaisir. REM sleep behaviour disorder in Parkinson’s disease is associated with specific motor features. J Neurol Neurosurg Psychiatry 2008;79:1117–1121. 3. Ruo-lin Zhu, Cheng-juan Xie, Pan-pan Hu, Kai Wang. Clinical variations in Parkinson’s disease patients with or without REM sleep behaviour disorder: a meta-analysis. Sci Rep. 2017 Jan 16;7:40779 4. Bargiotas P, Debove I, Bargiotas I, Lachenmayer ML, Ntafouli M, Vayatis N, Schüpbach MW, Krack P, Bassetti CL. Effects of bilateral stimulation of the subthalamic nucleus in Parkinson’s disease with and without REM sleep behaviour disorder. J Neurol Neurosurg Psychiatry. 2019 Dec;90(12):1310-1316. 5. Zibetti M, Rizzi L, Colloca L, Cinquepalmi A, Angrisano S, Castelli L, Lanotte M, Lopiano L. Probable REM sleep behaviour disorder and STN-DBS outcome in Parkinson’s Disease. Parkinsonism Relat Disord. 2010 May;16(4):265-9.

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